Tratamento reabilitador em dente afetado por hipomineralização molar- incisivo com fratura pós-eruptiva em paciente pediátrico: relato de caso

Abstract

Molar-incisor hypomineralization (MIH) is characterized as a qualitative defect of the enamel resulting from systemic disorders that affect the maturation phase of amelogenesis, resulting in reduced mineral density and increased tissue porosity. Clinically, it affects one or more permanent first molars and may also involve permanent incisors, since these structures have coinciding calcification periods. The clinical management of MIH encompasses a wide range of therapeutic approaches, which vary according to the severity of the lesions and the structural integrity of the affected enamel. The aim of this study is to describe the clinical management and minimally invasive restorative treatment of a tooth affected by molar-incisor hypomineralization (MIH) associated with post-eruptive breakdown, highlighting the treatment protocol, the operative steps, and the clinical outcome obtained. The patient, E.C.A.P., 11 years old, male, attended the Policlínica Odontológica da UEA (POUEA) by referral, accompanied by his guardians, in search of diagnosis and appropriate management. Upon clinical examination, well-defined opaque spots were observed, with coloration varying between yellow and brownish-yellow and a rough surface on tactile examination. These changes were present in the permanent upper right lateral incisor, the permanent lower left lateral incisor, and, more evident, in the permanent upper molars. Based on the anamnesis, past medical history, and findings obtained in the clinical examination, a diagnosis of molar-incisor hypomineralization (MIH) was established. Based on this diagnosis, an individualized restoration plan was defined. The present study is limited to reporting the clinical management of the permanent upper right lateral incisor, tooth 12, which presented, in addition to changes compatible with MIH, an associated post-eruptive fracture. A temporary diagnostic restoration was made, intended exclusively for color selection and definition of the stratifications that would be used in the final restoration. The sequential use of Luna A1, OA2, and A2 resins (SDITM, Austrália), associated with the intermediate increment of FiltekTM Z350 XT A2B (3M Espe®, São Paulo, Brazil), made it possible to compensate for the underlying coloration of the hypomineralized enamel and restore the value, chroma, and hue in a balanced manner. The clinical result obtained in this case confirms the feasibility of ultra-conservative approaches in teeth affected by HMI, especially when associated with diagnostic temporary restorations and controlled color selection. The satisfaction of the patient and those responsible, combined with immediate functional stability, reinforces that the strategy adopted has solid clinical applicability and can be used as a reference for similar cases. The case report presented demonstrated that the direct restorative approach with composite resin is an effective, conservative, and aesthetically satisfactory alternative for the rehabilitation of anterior teeth affected by Molar-Incisor Hypominereralization (MIH) associated with post-eruptive breakdown. It also highlights the feasibility of minimally invasive restorative alternatives in pediatric patients.